What are common intravenous (IV) antibiotics for the treatment of pneumonia?

From the Guidelines

Common IV antibiotics for treating pneumonia include piperacillin-tazobactam, cefepime, levofloxacin, imipenem, and meropenem, as recommended by the Infectious Diseases Society of America and the American Thoracic Society 1. When managing adults with hospital-acquired pneumonia, the choice of empiric antibiotic therapy depends on the risk of mortality and the likelihood of methicillin-resistant Staphylococcus aureus (MRSA) 1.

Key Considerations

• For patients not at high risk of mortality and without factors increasing the likelihood of MRSA, options include:
  • Piperacillin-tazobactam 4.5 g IV q6h
  • Cefepime 2 g IV q8h
  • Levofloxacin 750 mg IV daily
  • Imipenem 500 mg IV q6h
  • Meropenem 1 g IV q8h 1
• For patients at high risk of mortality or with recent intravenous antibiotic use, a combination of two antibiotics is recommended, including:
  • Piperacillin-tazobactam 4.5 g IV q6h
  • Cefepime or ceftazidime 2 g IV q8h
  • Levofloxacin 750 mg IV daily
  • Ciprofloxacin 400 mg IV q8h
  • Imipenem 500 mg IV q6h
  • Meropenem 1 g IV q8h
  • Amikacin 15–20 mg/kg IV daily
  • Gentamicin 5–7 mg/kg IV daily
  • Tobramycin 5–7 mg/kg IV daily
  • Aztreonam 2 g IV q8h 1

Additional Coverage

• Vancomycin 15 mg/kg IV q8–12h may be added for MRSA coverage, with a goal to target 15–20 mg/mL trough level 1
• Linezolid 600 mg IV q12h is an alternative for MRSA coverage 1 It is essential to consider local resistance patterns, patient factors like allergies and kidney function, and to narrow treatment once culture results are available 1.

From the FDA Drug Label

Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa Piperacillin and Tazobactam for Injection is indicated in adults for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae.

Common IV antibiotics for treatment of pneumonia include:

• Piperacillin-tazobactam, which is effective against nosocomial pneumonia caused by beta-lactamase producing isolates of Staphylococcus aureus, Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa.
• Piperacillin-tazobactam is also effective against community-acquired pneumonia caused by beta-lactamase producing isolates of Haemophilus influenzae. 2

From the Research

Common IV Antibiotics for Pneumonia Treatment

Some common IV antibiotics used for the treatment of pneumonia include:

• Ceftriaxone, which has been shown to be effective in community-acquired pneumonia at a dosage of 1 g daily 3
• Levofloxacin, a fluoroquinolone with a broad spectrum of activity against several causative bacterial pathogens of community-acquired pneumonia (CAP) 4
• New cephalosporins such as ceftolozane/tazobactam, ceftobiprole, ceftazidime/avibactam, and ceftaroline, which have a broad-spectrum of activity and favorable pulmonary penetration 5
• Beta-lactams with or without beta-lactamase inhibitors, aminoglycosides, oxazolidinones, quinolones, and tetracyclines, which are new classes of antimicrobials with potential for treating pneumonia 6

Antibiotics for Specific Types of Pneumonia

For Pseudomonas aeruginosa infections, novel fluoroquinolones and new combinations of β-lactams/β-lactamase inhibitors have been studied, and cefiderocol, a new cephalosporin, shows promising results 7 Combination therapy with anti-pseudomonal beta-lactam (or aminoglycoside) should be considered if Pseudomonas aeruginosa is the causative pathogen of the respiratory infection 4

Considerations for Antibiotic Choice

Antimicrobial therapy should be individualized considering local antimicrobial resistance and epidemiology, the stage of the illness, and potential host factors predisposing to a high risk for specific pathogens 5 Antimicrobial stewardship is essential to preserve new drugs and prevent future development of resistance 7